SURGICAL IMPLICATIONS OF LOWER THORACIC AND LUMBAR INDEPENDENT SYMPATHETIC PATHWAYS

Abstract

THE PERSISTENCE of functional sympathetic conduction pathways following extirpation of the sympathetic trunk or section of the communicating rami in man has been amply demonstrated.¹ Sympapathetic conduction pathways which do not traverse the sympathetic trunks have also been demonstrated anatomically.² Such pathways involve synaptic connections of preganglionic fibers which do not enter the sympathetic trunk with ganglion cells which are located outside the sympathetic trunk ganglions. Aggregates of sympathetic ganglion cells located in relation to communication rami, particularly gray rami, or sympathetic roots, have been reported.³ Alexander and others² have pointed out, on the basis of anatomic studies, that many sympathetic ganglions which are not incorporated in the sympathetic trunk are located in relation to the spinal nerves and their interconnecting rami. Some of them receive preganglionic fibers directly via the ventral nerve roots. In turn, postganglionic fibers arising in them extend distalward in the spinal